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Author
Topic: Am I in great danger? (Read 13778 times)

I was infected almost 4 years ago. Last year my viral load was 572 331, this year (1 week ago) 758 165.My CD4 last year 634 (21%) and this year (1 week ago) 369 (15%).No meds and I'm affraid to enter in the system in Canada for many professional and personnal reason. So I get tested in Bangkok where I was travelling for my work. I'm I in danger here? Do have I to start meds now? If not, how many time I got left? Maybe I will loose my job (and all I care about) if i'm going in the system with some country I will not able to enter anymore (essential to my job) because of my status.

I was infected almost 4 years ago. Last year my viral load was 572 331, this year (1 week ago) 758 165.My CD4 last year 634 (21%) and this year (1 week ago) 369 (15%).No meds and I'm affraid to enter in the system in Canada for many professional and personnal reason. So I get tested in Bangkok where I was travelling for my work. I'm I in danger here? Do have I to start meds now? If not, how many time I got left? Maybe I will loose my job (and all I care about) if i'm going in the system with some country I will not able to enter anymore (essential to my job) because of my status.

Thank you!A very affraid man...

No doubt a conga line of Canadians will point out that Canada has strong Anti discrimination policies regarding HIV, so I'll leave the bush-lawyering to them.

Are you in danger with those numbers?

Frankly yes. 21% is pretty much the border line where you need to consider starting medications. 15% is considerably below that.

You're in danger territory son.

Now, you might like your job but It's gonna be hard to do it if you're laid up in hospital with PCP. Would I seek treatment in Thailand or Canada?

That question is a bit like asking "Would I get open heart surgery from a cardio-thoracic surgeon or a vet?"

I hardly see why you would be afraid to "enter the system", especially if you're borderline with these numbers. You would have been best to test more than once a year, too...

Do you have private insurances with your work? Or are you on a public plan? Or have you been avoiding to pay any health insurance for some reasons? If you're on a private plan with a company that needs you to travel to Thailand for work, I'm pretty sure you will not bring your employer to bankruptcy, and if you're on a public plan, your employer will never know about this...

Thanks to you both! I live in Quebec but out of the country for another 2 months...I'm on public care. I think it's like 800$ ayear for meds. Not a problem.But now I'm a little bit nervous about the next 2 months...I hardly can go back before...Going to Indonesia next week for 6 weeks and come back to Canada.

I test only when I'm in Thailand to do some anonymous test of viral and CD4.I don't think Thailand is bad for HIV care. The clinic I go for testing it's beside the Thai red cross AIDS research centrer.

So do I wait to come back to Canada? I don't even know if I'm going to be able to enter in Indonesia with the meds and so the status...

Most countries now tell people they should start meds when the tcell count goes below 500, but only a few years back the generally accepted level was 350. Starting earlier helps preserve your immune system, but you are not in desperate straits should you need to wait a month or two until you get back to Canada.

It is important for your long term health that you start meds relatively soon, though, and do so in a considered manner with a commitment to staying on the meds and taking your pills each day. You might start practicing with a vitamin whilst you are still in Thailand.

For you, staying healthy with HIV is still a long-term proposition -- you need to get onto meds and stick with them starting fairly soon. If you delay, it may become a short-term proposition as well -- not the desirable course at all.

And indeed nobody has advocated that this new member panic. But there is certainly cause for concern in the numbers he has provided us with.

He needs to give careful consideration to his options. I'm sure that adequate services are provided in Thailand or Indonesia to those who can pay for them.

I'm nearly equally as sure that the services in Canada at least equal those available in Thailand. Sure you may not have the pleasure of chickens running around the waiting room in Vancouver but at least the public health will foot the bill.

Hi canadiandesperate, I live in Thailand and know of the place you go for checks,It is often when your cd4 is below 200 that they start you on meds here,having said that if you where to see a private hiv doc you would probably get put on meds.There are many of the western world meds available here if your paying for them,but if you start on meds here then your gonna have to follow through on the same meds in Canada one would think,also meds here are prescription only and most doctors dont give more than a one month supply at least until they establish that your doing ok on them.Another thing is that unless you request it,doctors wont normally do a resistance test here.No problems with chickens running round the clinics though lol.Like others have said,your gonna have to jump on the band wagon soon or you wont be fit to do a job anymore.There are some great hiv docs here by the way and i can point you in the right direction should you decide to get things rolling here,best wishes..

I agree with those who are saying that you need to start treatment, the sooner, the better. Not only do you have low CD4s, but your CD4% is also VERY low. Equally concerning is your VERY high VL. It's way too high and your CD4s are going to continue to decline as long as your high VL goes unchecked.

As most here know, I'm an advocate of waiting until your numbers indicate the need for treatment, and buddy, your numbers are absolutely screaming out for treatment.

Stop worrying so much about your job and start worrying about your life. No life = no job. There's no way around it.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

The nub of this seems that you need to get your head round being a Canadian with HIV. Having to tell eg yer boss, family, friends everything when you are hospitalised with PCP et al is no hot date to look forward to. Agree with what Ann, MattdeD etc said about your CD4% and need for treatment. This is not an ostrich moment.

I agree with the consensus here that you are risking illness with your numbers and the level off stress from the fear must be both horrible to live with and not helping with your overall health.

I confess to being curious as to the details off your fear and would urge you to find a trust worthy source to really test them out as Matty said Canada is not known for its discrimination. You could use here or seek another source that will give sound advice based on Law.

Newts point that with illness explanation will be necessary, is clear thinking,and from my own experience fear puts paid to clear thinking.

I hope this is helpful and that you Quickly reduce the burdon off fear and worry you have,take care off yourselfTheyer

Logged

"If we can find the money to kill people, we can find the money to help people ." Tony Benn

Bangkok's got some incredible medical care available. Lots of people go there from other countries because of their level of care (for cancer, surgeries, etc. ) In many of their facilities, the nurses wear crisp white uniforms complete with caps! And, in certain places there is tea and cookies available in the waiting room. Further, they are respectful about time and their pace can be somewhat Germanic. Quite impressive.

How soon are you due back in Canada? If it's not for a while, I'd consider starting care in Thailand. However, given that it seems you spend more time in CA than on the road, were I you, I'd rather get established with someone who's going to be in for the haul to get me squared away.

1. Opportunistic infections suck. I had PCP and spent 4 days in intensive care, a month in hospital and a total of 3 months off work. It took me 12 months to feel 'normal' again and not have to sleep during the day. It happens fast. I went from fine to tired to intensive care in 2 weeks. I'd only stay in Thailand if you can afford to do some serious hospital / recovery time there.

2. Starting meds isn't always smooth. I'd plan to be around a doctor for at least the first month or 2. Most people start and don't have any problems but there are some things that could require a change of meds or doctor input.

First, sorry for my English, sometimes Iím not sure about the word and verb...

I want to start my message by thanking you all! Thank to you people who donít really know other people here and take your time to read and answer messages and trying to help people. At first, when I learn about my status, I was so desperate and alone. No one to talk about my situation. Itís people from forum like this one who give me the strength to continue. So thank you all.

Last night, I went for dinner in a very nice rooftop lounge restaurant with the only friend I have here in Bangkok. We eat good food, talk, have fun and drink a lot of wine. I know it wasnít the best idea with my fragile health to drink a lot of wine but it make me feel good and forget for a moment. After I leave him, I grab a cab and go to one of the only gogo bar girls Iíve been here to see that beautiful, sweet and very smiling girl I saw at that time. I ask (and pay) her to come back to my hotel with me. We didnít have sex, really didnít want to with my mood...just cuddling. So the plan was just to sleep beside someone because I feel so alone at this moment. When I wake up this morning, back to reality, I said to myself: I want to have more dinner like yesterday with friends, I want to live! So today, I wrote an email to the person I saw at first last year here in Thailand to ask about what he think about my result (because when they send it to you by mail they donít comment). He answers me to come without appointment to meet him and he was worried too about my result, especially about the 50% drop of CD4 from last year. So tomorrow I will go there to see him...and I will come back to you on that. If he want me to start me right now on meds (and if I agree) or wait until comeback to Canada, do you have any suggestion of meds for me? I donít know a lot about the meds...Is there a meds who have less side effect and still efficiency. I can live with side effect that other people cannot see (like headache and nausea) but what afraid me is drastic change in my body, face and stuff like that.

What afraid me about my job itís about the travelling part of my job. Iím afraid to lose my job only if I cannot travel to some country I will not be useful for my company anymore and will have to tell them why I cannot enter in a country... I donít know about now with Obama but I remember when Bush was there, we cannot enter in the country if we were HIV +. Donít know about now, donít know about other country...If I lose my job because of that, I will not engage a legal fight with my company because I donít want to become public with my status...another reason why I have to take meds and stay away from PCP and shit like that (so agree with newt (Matt)).

Last year, I know I was at the limit but I take a cocktail everyday of all the good natural product was supposed to be good for viral load and CD4 and other stuff (Selenium, curcuma + bromelain, deglycyrrhizinated licorice root extract, vitamin C, garlic) and hope to give me enough time to see a miracle in a cure. But seems like time not playing for me (maybe it make stay away from some disease because I didnít get sick in the last 2 years)...either the big lucrative market of the powerful and greedy pharmaceutical company wasnít on my (our) side...so I think I donít have choice anymore now.

Thanks to you all one more time! You are kind of hero for me and a reel example of courage for what youíve been thru and to be here and share!

I come back to you soon. Take care all!

P.S. No there is no chickens running everywhere in the waiting room! lol People here are the most kindly person Iíve met in my life and Iím sure they are very qualify too. Canadian health care system is a reel mess and have to wait forever for care (maybe not in the case of HIV but for sure I donít want to be treated for PCP there).

Travel restrictions are getting to be less of an issue around the world but some still exist. This site http://www.hivtravel.org/ lets you explore restrictions by country both for travel and for immigration (where restrictions tend to be more significant).

Thank you Assurbanipal! This will be very useful for travel and for meds when I look at my option with the doctor here tomorrow. As for the country I think itís not that bad for me...China was a big ? but seems to be ok now.

"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Canadian health care system is a reel mess and have to wait forever for care (maybe not in the case of HIV but for sure I donít want to be treated for PCP there).

I'm not really sure why you wouldn't want to receive your HIV care in Canada. Our system can't honestly be described as a "mess". Yes, there are some wait times for elective procedures, but overall, the health care that I have received has been nothing short of amazing. Long visits with my doctors, endless diagnostic tests to make sure my health is okay, lots of monitoring and follow up, excellent access to meds (including full coverage for low income folks as part of our social safety net)... all in all, the care is universal and outstanding. I think your fretting about the level of care in Canada is totally unwarranted and a bit ridiculous.

As for your concerns about anyone finding out your status, those concerns are also unwarranted. We have iron clad privacy laws in Canada that protect your medical information. Your employer won't know anything unless you choose to tell them. Your insurance company won't tell your employer anything about your claims you make, and neither will your medical team. In addition to federal privacy laws, each province also has legislation to protect individuals' privacy. Medical information is one of the most sacred types of information that privacy laws protect.

It's great that you are moving forward with your treatment in Thailand, but remember that the standard of care in Canada is excellent, and you really don't have to worry about it.

Bangkok's got some incredible medical care available. In many of their facilities, the nurses wear crisp white uniforms complete with caps! And, in certain places there is tea and cookies available in the waiting rooms. Quite impressive.

Sorry Steve as much as you tout your "social safety net" and iron clad privacy laws, it just simply cannot compare to Thailands crisp white uniforms and excellent use of tea and cookies. Canada should really learn its place.

Thank you Steve but of what I see, you are from Toronto maybe we are both Canadian but Iím not sure it's the same in both provinces. When I had my primary infection (was really sick) and didn't think about having HIV at all at that time (just having one girl sex partner after been annually test because of multiple partners), I spend 20 hours waiting (15 waiting in the waiting room and 5 in a bed in the hallway finally because I was sweating, nausea...in the waiting room) lots of test later, they didn't find what I've got, they want to do more test in 3-4 hours, have to wait for the biologist or someone else, I finally ask to leave to get in my bed and wait for the day after because not only I hate hospital but being reel sick in a hallway itís nothing fun. Iíve got better and never get back. 3 of my good friends are nurses, one of them leave for Switzerland because she was exhausted of the 20 hours shift (like almost all nurses in Quebec). But they are one of the best nurses in the world, the problem, like for our doctor, they have a reel staff problem in quantity. Iím sure I will be fine with the HIV treatment in Quebec because you have appointment, I just donít want to be sick there (PCP...) and neither here by the way.

About the discretion of the system, 10 years ago, the new boyfriend of my ex girlfriend who was a pharmacist, didnít like me, taught maybe I try to comeback with her, told her that I had papillomavirus to turn her off...well heís still a pharmacist, still donít like me (jealous) and still an as****le! He would be please to have that kind of scoop especially now because Iím starting to be known in the community...Donít want that at all. Not good for my job either...I think all the pharmacies are connected together. But now, I have to take care of myself and take the risk about my status going public, losing my job, facing the stigma...

And please everyone, there is good doctor everywhere in the world so don't have too much prejudice about poor country because they have a heart, they can care and in general, they care more about people than money and some of them had very good education (some in the USA). After all, the best doctors in the world are supposed to be in Cuba (a reel poor country). The cookies thing is not essential in the health care but it show me how much Thai people are caring people. We have cookies (and all greasy food in our hospital) too in Canada but we have to pay for it!

Still, the best thing for me is to go back to Canada in the next days but I donít have any appointment there, have to maybe wait and Iím afraid to take a 23 hours (not sleeping well or at all) flight and waiting airport beside people (and so multiple potential virus with a bad immune system)...This and have to answer some questions about my early comeback and not finishing my work...So I will see with the Thai doctor tomorrow (without the chickens running and maybe with some cookies;) what's are the best thing to do for me.

Thank you Steve but of what I see, you are from Toronto maybe we are both Canadian but Iím not sure it's the same in both provinces.

I hear what you are saying about emergency room wait times...they are pretty brutal when you have been triaged down the ladder in importance. My comments were more focussed on more "routine" care from an HIV specialist. Also, if you had a serious situation like PCP, you'd be admitted to the hospital and not waiting in a hallway in the emergency department (at least I would hope not). I take your point that hospitals are probably different in our two provinces.

Sorry Steve as much as you tout your "social safety net" and iron clad privacy laws, it just simply cannot compare to Thailands crisp white uniforms and excellent use of tea and cookies. Canada should really learn its place.

I think you may have something here... Our lack of crisp white uniforms is clearly unacceptable... uh...and cookies? That's a nice touch. I never get cookies at my doctor's appointments. Shame on Canada!

Last year, I know I was at the limit but I take a cocktail everyday of all the good natural product was supposed to be good for viral load and CD4 and other stuff (Selenium, curcuma + bromelain, deglycyrrhizinated licorice root extract, vitamin C, garlic) and hope to give me enough time to see a miracle in a cure. But seems like time not playing for me (maybe it make stay away from some disease because I didnít get sick in the last 2 years)...either the big lucrative market of the powerful and greedy pharmaceutical company wasnít on my (our) side...so I think I donít have choice anymore now.

Let me get this straight. You have been waiting for a "miracle cure". You think the powerful and greedy PHARM industry has it in for HIV+ people and is blocking a cure? And, you have been taking supplements thinking this could help you get to the cure date.

Listen, only 2 things determine your progression from infection to AIDS. 1) Genetics. 2) If when its your time, you take HAART, you don't get AIDS.

If I had a penny on every dollar wasted on supplements taken in the hope of fighting this virus, I'd be a multimillionaire and probably yes, a big contributor to scientific research on the AIDS CURE.

Logged

ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Thank you Steve but of what I see, you are from Toronto maybe we are both Canadian but Iím not sure it's the same in both provinces. When I had my primary infection (was really sick) and didn't think about having HIV at all at that time (just having one girl sex partner after been annually test because of multiple partners), I spend 20 hours waiting (15 waiting in the waiting room and 5 in a bed in the hallway finally because I was sweating, nausea...in the waiting room) lots of test later, they didn't find what I've got, they want to do more test in 3-4 hours, have to wait for the biologist or someone else, I finally ask to leave to get in my bed and wait for the day after because not only I hate hospital but being reel sick in a hallway itís nothing fun. Iíve got better and never get back. 3 of my good friends are nurses, one of them leave for Switzerland because she was exhausted of the 20 hours shift (like almost all nurses in Quebec). But they are one of the best nurses in the world, the problem, like for our doctor, they have a reel staff problem in quantity. Iím sure I will be fine with the HIV treatment in Quebec because you have appointment, I just donít want to be sick there (PCP...) and neither here by the way.

About the discretion of the system, 10 years ago, the new boyfriend of my ex girlfriend who was a pharmacist, didnít like me, taught maybe I try to comeback with her, told her that I had papillomavirus to turn her off...well heís still a pharmacist, still donít like me (jealous) and still an as****le! He would be please to have that kind of scoop especially now because Iím starting to be known in the community...Donít want that at all. Not good for my job either...I think all the pharmacies are connected together. But now, I have to take care of myself and take the risk about my status going public, losing my job, facing the stigma...

And please everyone, there is good doctor everywhere in the world so don't have too much prejudice about poor country because they have a heart, they can care and in general, they care more about people than money and some of them had very good education (some in the USA). After all, the best doctors in the world are supposed to be in Cuba (a reel poor country). The cookies thing is not essential in the health care but it show me how much Thai people are caring people. We have cookies (and all greasy food in our hospital) too in Canada but we have to pay for it!

Still, the best thing for me is to go back to Canada in the next days but I donít have any appointment there, have to maybe wait and Iím afraid to take a 23 hours (not sleeping well or at all) flight and waiting airport beside people (and so multiple potential virus with a bad immune system)...This and have to answer some questions about my early comeback and not finishing my work...So I will see with the Thai doctor tomorrow (without the chickens running and maybe with some cookies;) what's are the best thing to do for me.

Here it's the night, so good day all and good night for me.

I'm curious where you get your health care in Quebec, because I live in Montreal and our system is excellent. I've been here four years, to the ER many times and have never encountered what you describe. I get my HIV care from the specialty clinic at CHUM and yesterday, when I needed to see a doctor, without an appointment, I was there for a total of 3 hours. During that time I got full sinus and chest x-rays, some cultures taken and 40 minutes with an HIV specialist.

If you decide to get your care in Quebec, you should find an HIV specialist connected with a hospital. To use the example of being kept waiting in the ER, when you don't know which other types of patients were there, as a criticism of the Quebec health system is horribly unfair. Most probably, you had to wait, because you were not dying and patients are taken in order of need, not arrival. Socialized medicine includes some compromises, but I have never heard any of my friends complain about the health care they receive.

Based on your VL (>100'000), CD4 (<500) HAART is recommended for you.Also, some health care providers use the CD4% going below 15% as a sign to start HAART, even if the CD4 count is high.

See the U.S. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents - January 10, 2011

Genotype assay testing is recommended at the time of entry into HIV care, regardless of whether therapy is initiated immediately or deferred. As such, this is something you may want to do now.

Understand that you will have to start HAART sooner or later (the sooner the better). HAART are highly effective today, are still a life time commitment, but when the time has come, they become no more optional. Delaying won't be of any help. But put you at risk.

You may have to enter in a health care system of your country to get your meds, do your labs and see an I.D. Doc, but if you have the possibility to do so, you can do that abroad (such as in Thailand). If you are buying your meds abroad, ensure you are getting them from a trusted place (good hospitals, Red Cross, etc.) to avoid copies.

Excepting if you are asking for a residence permit or long stay in some countries, you don't have to provide a HIV test to get a tourist or business visa, but to fill a form. If so, I would recommend you to not say that you are positive.

About those you care about, disclosing is your choice. So far, I have disclose only to my partners and health care providers. Nothing should change for you now you are not on meds, compared to after starting meds. You doc won't tell it to any one.

Sorry Steve as much as you tout your "social safety net" and iron clad privacy laws, it just simply cannot compare to Thailands crisp white uniforms and excellent use of tea and cookies. Canada should really learn its place.

Ahhh Buggy. If you read my post, I suggested he base his care location on urgency and encouraged Canada if that is where he spends the majority of his time. Having received care in Thailand, I wrote from experience -- not HIV care, but care nevertheless and in Bangkok---not a small town setting. The reference to garb was that it is such a throwback to US nursing uniforms in the 50s. It's striking--purely anecdotal. However, they are super-respectful of people and people's time -- and canadiandesperate wasn't certain where he would seek care. So, just like in all the other threads everyone of us tosses their best bits in. My friends in Canada like their medical care. Isn't it grand that he has two countries from which to choose?

Em, I was just being sarcastic. I realize I usually fail at being funny but sometimes I just can't help myself. I appreciate Thailand's use of tea and cookies and their strict adherence to crisp white uniforms. I appreciate a sense of style and decorum when I receive my health care. Way too often the medical care in the US lacks style.

On a more practical note, putting aside the cookies and 1950's nurses I think I would still have to choose Canada's healthcare system over Thailand's. That's just my opinion. The reasons for this are Thailand waiting to initiate treatment until a persons cd4 drop to 200 and their lack of using resistance testing and the choice in medications available. However, I do agree that in the OP's case he needs to start treatment NOW. His CD4 percentage is dangerously low. Regardless if he chooses that care in Thailand or Canada he needs to see a doctor.

Let me get this straight. You have been waiting for a "miracle cure". You think the powerful and greedy PHARM industry has it in for HIV+ people and is blocking a cure? And, you have been taking supplements thinking this could help you get to the cure date.

Listen, only 2 things determine your progression from infection to AIDS. 1) Genetics. 2) If when its your time, you take HAART, you don't get AIDS.

If I had a penny on every dollar wasted on supplements taken in the hope of fighting this virus, I'd be a multimillionaire and probably yes, a big contributor to scientific research on the AIDS CURE.

Yes I do hope for a cure soon because I want to have a love life again. Donít want to be a big victim here but being a HIV + straight man in a very small town in a big country with not many citizens, find an HIV+ girl (on the 20 that are on dating site in my big province) itís not a lot of option for a passionate guy like me who want someone compatible with me and not just find someone looking for someone...Many more option in the gay community (donít want to have a prejudice here but anyone know itís a fact). Try 2 times with a negative girl and it was a reel mess! One of them wants money to keep the secret...So yes I really hope for a cure and Iím really frustrated about the time it take to find a cure cause lack of money in that non lucrative department. I still believe in the honesty of the biologists whoís working their life on finding a cure and good medication. Iím very grateful for the work done in the meds since that shit appear from ďnowhereĒ. And no, I didnít think natural product will cure me, make me undetectable and will never have to take meds but I was hoping it will give me more time and time is the only thing who will make a cure possible. The miracle cure I was talking about was that they finally approve something they are working on right now so maybe the miracle was too strong...

Em, I was just being sarcastic. I realize I usually fail at being funny but sometimes I just can't help myself. I appreciate Thailand's use of tea and cookies and their strict adherence to crisp white uniforms. I appreciate a sense of style and decorum when I receive my health care. Way too often the medical care in the US lacks style.

I'm curious where you get your health care in Quebec, because I live in Montreal and our system is excellent. I've been here four years, to the ER many times and have never encountered what you describe. I get my HIV care from the specialty clinic at CHUM and yesterday, when I needed to see a doctor, without an appointment, I was there for a total of 3 hours. During that time I got full sinus and chest x-rays, some cultures taken and 40 minutes with an HIV specialist.

If you decide to get your care in Quebec, you should find an HIV specialist connected with a hospital. To use the example of being kept waiting in the ER, when you don't know which other types of patients were there, as a criticism of the Quebec health system is horribly unfair. Most probably, you had to wait, because you were not dying and patients are taken in order of need, not arrival. Socialized medicine includes some compromises, but I have never heard any of my friends complain about the health care they receive.

Maybe HIV people have an advantage in the healthcare system in Quebec! This is what appears to be with what you said. Maybe is the only advantage we have! I live in a very small town without any HIV specialist 75 km around (but I have a car)...but what do you think about líActuel in Montreal? I hear mixed review...

It never fails to amaze me how some folks develop these really novel approaches to dealing with a life threatening disease.

Glad to amaze you! People are different in a different environment and don't live the same situation like everybody...This is why compassion is the most beautiful thing in life and judgment the worst...

And yes my first choice is to comeback in Canada for the treatment but with the plane and my health status who seem to be in a danger zone, I'm afraid of the flight like I said. We will see that in a couple of minutes with the doc here.

Seem that in the Montreal big clinic, the preferred starting meds are Prezizta with Novir and Truvada seem to be working good and not much side effect. What do you think about that?

Mate, it's alright to wait for a cure and be hopeful as long as you go on HAART before your immune system is severely compromised and yours in getting to that point.

You do know that initiating therapy at CD4 above 350 (21%) is now recommended almost everywhere in the world, right? It is proven in clinical trials that waiting longer than this can cause you harm somewhere down the road.

Basically, don't wait to start. Not any longer.

Canada, Thailand and the logistics can be worked around later but just start asap.

PS- A lot of gay men can give straight girls stiff competition in being HIV-phobic, I think. People are people. When you meet the right person, that's all that matters- gay or straight, poz or neg.

PS- A lot of gay men can give straight girls stiff competition in being HIV-phobic, I think. People are people. When you meet the right person, that's all that matters- gay or straight, poz or neg.

You are right about people are people! But maybe I'm wrong but I still think when you tell a girl you are poz and she know you are straight she is way more surprise than a gay men tell to another gay men. I'm the perfect example of being straight and still catch that shit but a lot of straight people (especially girls) think it's still a gay disease sadly.

Yes I know I have to start like now but still wandering if I come back to Canada now or start treatment here and continue my trip and work for one more month. This is what Iím going to find out in couple of minutes because Iím going to see the doctor now.

hello canadiandesperate,my support to you is if in case you need any more informations like hiv specialist DRin thailand or hospital, do not hesitate to ask me or send mail i can do my best to help you. i live in thailand okthakx sanitex

hello canadiandesperate,my support to you is if in case you need any more informations like hiv specialist DRin thailand or hospital, do not hesitate to ask me or send mail i can do my best to help you. i live in thailand okthakx sanitex

Thank you very much sanitex! But time is running out for me to have more consultation in Bangkok because I leave sunday.

Well, this is the last news: I saw the doctor (maybe more of a councillor) and suggest me to start meds now with Atripla. Then I told him my story about the rest of my trip for the next 6 weeks. He suggest to have another CD4 check-up tomorrow just to be sure and if itís not worst than 2 weeks ago he tell me that I can wait 6 more weeks and really donít seem panic with my result for another 6 weeks without meds. I will have my result Saturday by mail and I have to take the plane Sunday for Indonesia. So I will see then but I think I will go to Indonesia at least one week (the most important week of my job) and after that maybe I will comeback. For sure, if I was in Canada now, I will start on meds right away but the story is different...I donít even know if their Atripla is a generic and he told me they donít have all of our medication available. So the choice is limited and I know that if I start something you have to stick with it for long time. So the final decision is not make yet but I will see Saturday.

To answer your original question, are you in great danger? the answer is no. Your CD4% is a somewhat low for your CD4 count, and suggests you should consider antiretroviral treatment soon, but waiting til you return to Canada to start medication isn't going to be a major risk. I would personally pay attention to preventing diarrhea, malaria and the like in the mean time (the usual travel precautions then).

To answer your original question, are you in great danger? the answer is no. Your CD4% is a somewhat low for your CD4 count, and suggests you should consider antiretroviral treatment soon, but waiting til you return to Canada to start medication isn't going to be a major risk. I would personally pay attention to preventing diarrhea, malaria and the like in the mean time (the usual travel precautions then).

- matt

Thank you Matt! And I will be careful with diarrhea. I'm always taking multi probiotique and I have activated vegetal charcoal pills in case of diarrhea and work fine with me even here in Thailand where diarrhea is a common problem for tourists even if it's the best food in the world the hygiene is not...

Most countries now tell people they should start meds when the tcell count goes below 500,

Not true at all. That is the point of the 'START' trials.Not a single European country guidelines currently recommend treatment above a CD4 cell count of 350, unless the person also has a consistent CD4 % below 14% (21% is not borderline in their guidelines) *or* they are also co-infected with Hep B or C for which they are also being recommended treatment, *or* they are over 50 and have indications of a disposition to Cardio Vascular Disease, *or* they are experiencing ill-health with OIs.

So if Canadiandesperate was anywhere in Europe, he would be being monitored carefully and advised that if his current numbers drop any further over at least two testing cycles (6 months) he would be recommended to start HAART, and should now prepare himself for that possibility.Unless he met the other criteria (Hep B/C, actual ill-health, Cardiovascular dispositions or age) he would not be recommended to start but would be offered the *option* to start straight away *if* he so wished..

One - seems to be years of somewhat denial and/or false hopes about how to battle HIV. So psychological/emotional.

Two - where and how to enter treatment phase, now that his numbers are indicated its about time. so medical and strategic - where to work, live, and get treatment - so how to live with HIV in the treatment phase of our lives.

I don't think members are encouraging him to panic but yes, time to face reality and start some decisions.

Matt39, is it my false memory, or do I notice you show up in such threads when people are dealing with the two challenges and -- though your agenda is not outright anti-haart, there is something counter-productive about the discourse.

Well anyway, its all well and good if canadianD continues to actively deal with the two challenges, without too much panic.

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ďFrom each, according to his ability; to each, according to his needĒ 1875 K Marx

Matt39, is it my false memory, or do I notice you show up in such threads when people are dealing with the two challenges and -- though your agenda is not outright anti-haart, there is something counter-productive about the discourse.

I was simply pointing out a glaring inaccuracy in two posts.

He asked simply if he was in danger now not being on HAART, and apart from the fact no one here actually is qualified to say either way, the fact is his numbers alone under guidelines operating in most of the world apart from North America, don't indicate that and if he is not also co-infected with Hep B or C and he is not suffering any ill-health then his situation is sufficiently fine for him to come to a considered and calm decision.

It is critical that canadiandesperate is given *accurate* information - if he is told his numbers are actually critically bad and, in any case, everywhere in the 'world' the advice is to go on HAART straight-away (which they are not and it isn't) he is getting inaccurate judgemental information from people who are not qualified to give it.

And it is critical that he does not get panicked or driven into a state of fear or extreme stress, let alone depression, because those states *are* immuno suppressive and they *are* a trigger for ill-health, even in the HIV negative population.

Only he will know what his overall health has been over the last few weeks and months and that is important for him to keep close to, and unless it has been poor he can count a positive situation.

There is no urgency for him to begin any treatment before he returns to Canada, if he wishes to wait, and to engender a feeling in him that he *must* is not supportive or responsible.Adherence to ARVs is critical, and adherence is almost always fragile when people feel bumped into it too quickly.

So taking his circumstances into account means supporting him to be calm and considered.

Most countries now tell people they should start meds when the tcell count goes below 500,

Other Matt is correct, only in the US is this routine advice, it's 350 elsewhere.

Quote

if Canadiandesperate was anywhere in Europe, he would be being monitored carefully and advised that if his current numbers drop any further over at least two testing cycles (6 months) he would be recommended to start HAART

But I think not on this one, at a CD4 count around 360-370 and a CD4% of 15 I believe most docs in Europe, and all docs in my clinic, would be moving for an immediate retest to check this is the real level, and if so talking about starting combination therapy ASAP.

Other Matt is correct, only in the US is this routine advice, it's 350 elsewhere.

But I think not on this one, at a CD4 count around 360-370 and a CD4% of 15 I believe most docs in Europe, and all docs in my clinic, would be moving for an immediate retest to check this is the real level, and if so talking about starting combination therapy ASAP.

- matt

I'm grateful to you for confirming the current guidelines outside of the USA.

As for the specific numbers and percentages for canadiandesperate I would beg to differ, at least as far as the UK is concerned.One CD4 count of 360-70 on its own (even with a percentage of 15%) is statistically insignificant. The BHIVA (British HIV Assoc) guidelines - which the National Institute for Health & Clinical Excellence concurs with - view those initial figures as the time to prepare a person for potentially imminent decision on whether or not to start HAART, but without co-infection with Hep B or C *and* a recommendation for treatment for those *or* current ill-health with specific OIs *or* co-factors around age and specific factors for Cardiovascular disease, they would still need to see a trend or consistency over two testing periods. They may well want an earlier retesting - at 8-10 weeks rather than a further 12-13 weeks. And of course, if a person pro-actively wanted to start HAART (even at higher whole numbers and percentage than 370/15%) that option would almost certainly be agreed to.The important thing for the HIV Specialist would be seeing a consistency to the numbers and preparing the person, in order to achieve start for HAART at the best possible time for the person (work wise, location etc) in order to ensure the best possible chance of early consistent adherence.

I know from my own HIV Consultant who is the Lead HIV Clinician in a major London HIV Clinic, that his approach is pretty much as I described above, and I know from my work with the patient support group there that it is a tried and trusted approach that fits well in supporting people.

That kind of sound basis for person treatment is not helped by individualistic judgements shown by many comments here, and talk of 'denial' or 'you must get on them now!' is virtually never anything but potentially harmful and unhelpful.

One - seems to be years of somewhat denial and/or false hopes about how to battle HIV. So psychological/emotional.

Two - where and how to enter treatment phase, now that his numbers are indicated its about time. so medical and strategic - where to work, live, and get treatment - so how to live with HIV in the treatment phase of our lives.

I don't think members are encouraging him to panic but yes, time to face reality and start some decisions.

Matt39, is it my false memory, or do I notice you show up in such threads when people are dealing with the two challenges and -- though your agenda is not outright anti-haart, there is something counter-productive about the discourse.

Well anyway, its all well and good if canadianD continues to actively deal with the two challenges, without too much panic.

I am completely aligned with this thought. Matt39 only comes into threads to discourage people on the fence of starting treatment (and to throw around all the "experts" that is friends or acquainted with). The fact is that treatment IS moving to earlier and while very few have said he "must" start -- they are saying it is time to seriously consider it. Even Ann, who is always a voice for starting ONLY when one's number truly indicate it has weighed in here. No, we are not experts -- but then neither is Matt39, despite all his imaginary illumiinaries -- but he didn't ask experts, he asked us. Oh -- and from his name, I'm guessing the OP isn't from Europe.

To the OP -- if it were me, I would be starting meds now -- so long as you are ready to take on the responsibility of taking them for the long haul here.

Good luck and try not to let people like Matt39 and his agenda dissuade you from doing what is right for YOUR health.